Bioelectrical impedance as a discriminator of pressure ulcer risk.

In an effort to identify objective measures of tissue structure and function associated with pressure ulcer risk, bioelectrical impedance analysis (BIA) was measured in three progressively larger zones over the trochanter and coccyx in patients assessed at high risk for pressure ulcers (HR group) and age-matched normal controls (CONT group). Local BIA measures were significantly lower in the HR group for each individual site and zone (p < .01). Full-thickness tissue biopsies obtained from each measurement zone did not differ between groups. However, additional nutritional and metabolic parameters were significantly different (p < or = .05). These results suggest that local BIA may be useful in assessing pressure ulcer risk.

Skin care in the frail, elderly, dependent, incontinent patient.

Despite a plethora of recommendations, protocols and dictums in the nursing literature, no research studies have defined the basic elements of preventive skin care for incontinent patients, and the prevalence of skin problems associated with incontinence is unknown. Yet the importance of skin care for incontinent elderly or immobilized patients has long been acknowledged. This literature review sought to determine current practices and principles for skin care of frail, elderly, dependent, incontinent patients. Protocols vary widely. And although there is mounting evidence that incontinence, particularly fecal incontinence, is a primary risk factor for pressure ulcer development, most preventive efforts focus on pressure relief, repositioning, and nutrition, rather than incontinence care. More clinical trials are needed in this area. The design and analysis of these trials should take into account the frequency and manner in which skin is cleansed, products used for skin care, risks and benefits of absorbent products and devices, the presence of infection, and patients' concomitant medical conditions and degree of immobility.

Perioperative teaching and counseling.

BACKGROUND: Patients who undergo surgery for colorectal cancer resulting in an abdominal stoma need extensive teaching and counseling to fully recover and enjoy a satisfactory quality of life. METHODS: The economics of health care, changes in length of hospital stay, what and how patients are taught, and ways in which adults learn were reviewed. Each of these influences on acquisition of self-care skills and knowledge were considered as they apply to the specific needs of stoma patients. RESULTS: Common misconceptions about ostomies should be dispelled to clear the way for adults to learn what they need to know to care for their ostomy. Postoperative teaching must wait until patients are alert and comfortable enough to attend to instruction. Educational material should be prepared at the patient's level of understanding. CONCLUSIONS: An adequate budget for education and dedicated patient education personnel are necessary for effective perioperative teaching and counseling of ostomy patients. In today's health-care system, patients who require a stoma need access to outpatient preoperative and postoperative training and emotional support.

Wound dressings of the nineties: indications and contraindications.

A revolution in wound management has occurred over the past 3 decades. A plethora of wound care dressings appear to enhance the wound repair process in acute and chronic wounds. However, extensive research is needed to discriminate between the beneficial effects of increased attention to all aspects of patient care, including wound management, and the salutary effects of dressing materials.

Pregnancy and sexual function in women with bladder exstrophy.

As a result of improved surgical and medical treatment, an increasing number of women with bladder exstrophy are reaching childbearing age. Unfortunately, little data exist regarding their sexual capacity, fertility, and potential complications of pregnancy. To assess these parameters, the medical records of 40 women ranging in age from nineteen to thirty-six years who had been treated in infancy for bladder exstrophy were reviewed. The 14 pregnancies in 11 women (25%) resulted in 9 successful deliveries, 3 spontaneous abortions, and 2 elective abortions. Nine women in this group had previous urinary diversion. Twelve of the 40 women agreed to participate in a survey of sexual capacity. Eight of this group reported that they engaged in regular sexual activity. Six reported regular orgasms, 4 dyspareunia, and 5 dysmenorrhea. Five of these women had achieved 7 pregnancies, and only 1 woman in this group who desired pregnancy had been unable to conceive. Complications during pregnancy included: uterine prolapse in 7, acute pyelonephritis in 1, prolapsed ileal conduit in 1, and transient urinary incontinence in 1.

"O" ring urinary ostomy appliance.

A non-adhesive urostomy system represents a major departure from ostomy appliances that have been used to date. Experience of 123 ostomates who have lived with the traditional as well as the new appliance indicates a high degree of patient acceptance and satisfaction. The "O" ring appliance promises to simplify and improve the quality of life for patients who are committed to this form of urinary disposition.